History: June Sp. Sess. P.A. 00-2 effective July 1, 2000; P.A. 04-76 amended Subsecs. (a) to (c), inclusive, by deleting
references to "general assistance"; P.A. 05-280 amended Subsec. (a) by replacing "establish a plan for the" with "require"
re prior authorization, removing former Subdiv. (1) designator, "initial" and "that costs five hundred dollars or more for
a thirty day supply or", redesignating existing Subdiv. (2) as Subdiv. (1), adding new Subdiv. (2) re prior authorization
requirement for brand name drugs when a chemically equivalent generic drug product substitution is available, and providing that authorization for brand name drug shall be valid for one year from the date the initial prescription is first filled,
amended Subsec. (b) by deleting provision that required commissioner to establish a plan for designating certain suppliers
of prescription drugs to be used by pharmacies when ordering prescription drugs and amended Subsec. (d) by adding "on
and after July 1, 2005," re submission of plan revisions to General Assembly, effective July 13, 2005.
Sec. 17b-492. (Formerly Sec. 17a-343). Eligibility. Registration fee. ConnPACE program requirements related to the establishment of the Medicare
Part D program. Payment for original and replacement prescriptions. Application
prior to exhausting coverage. Regulations. (a) Eligibility for participation in the program shall be limited to any resident (1) who is sixty-five years of age or older or who
is disabled, (2) whose current annual income at the time of application or redetermination, if unmarried, is less than twenty thousand eight hundred dollars or whose annual
income, if married, when combined with that of the resident's spouse is less than twenty-eight thousand one hundred dollars, (3) who is not insured under a policy which provides
full or partial coverage for prescription drugs once a deductible is met, except for a
Medicare prescription drug discount card endorsed by the Secretary of Health and Human Services in accordance with Public Law 108-173, the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003, or coverage under Medicare Part D
pursuant to said act, and (4) on and after September 15, 1991, who pays an annual thirty-dollar registration fee to the Department of Social Services. On January 1, 1998, and
annually thereafter, the commissioner shall increase the income limits established under
this subsection over those of the previous fiscal year to reflect the annual inflation adjustment in Social Security income, if any. Each such adjustment shall be determined to
the nearest one hundred dollars.
(b) (1) Payment for a prescription under the program shall be made only if no other
plan of insurance or assistance is available to an eligible person for such prescription
at the time of dispensing, except for benefits received from an endorsed Medicare prescription drug discount card or benefits provided under Medicare Part D. The pharmacy
shall make reasonable efforts to ascertain the existence of other insurance or assistance,
including the subsidy provided by an endorsed Medicare prescription drug discount
card or benefits provided under Medicare Part D. A Medicare prescription drug discount
card beneficiary shall be responsible for the payment of any Medicare prescription drug
discount card coinsurance requirements, provided such requirements do not exceed the
ConnPACE program copayment requirements. If a Medicare prescription drug discount
card beneficiary's coinsurance requirements exceed the ConnPACE copayment requirements, the Department of Social Services shall make payment to the pharmacy to cover
costs in excess of the ConnPACE copayment amount. If the cost to such beneficiary
exceeds the remaining available Medicare prescription drug discount card subsidy, the
beneficiary shall not be responsible for any payment in excess of the amount of the
ConnPACE program copayment requirement. In such cases, the Department of Social
Services shall make payment to the pharmacy to cover costs in excess of the ConnPACE
copayment amount.
(2) A Medicare Part D beneficiary shall be responsible for the payment of Medicare
Part D copayments, coinsurance and deductible requirements for Medicare-Part-D-covered prescription drugs, as defined in Public Law 108-173, the Medicare Prescription
Drug, Improvement, and Modernization Act of 2003, to the extent such requirements
do not exceed the ConnPACE program copayment requirements. The Department of
Social Services shall pay Medicare Part D monthly beneficiary premiums on behalf of
the beneficiary. If a Medicare Part D beneficiary's out-of-pocket copayment, coinsurance or deductible requirements exceed the ConnPACE copayment requirements, the
department shall make payment to the pharmacy to cover costs in excess of the ConnPACE copayment amount. The department shall be responsible for payment of a
Medicare-Part-D-covered prescription drug obtained during the gap in standard Medicare Part D coverage. To the extent permitted under said act, such payment may be
made by the department for a prescription at (A) the lower of the price that would be paid
under the ConnPACE program or the negotiated price established by the beneficiary's
Medicare Part D plan pursuant to Public Law 108-173, the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003, or (B) in consultation with the Secretary
of the Office of Policy and Management, at the price that would be paid under the
ConnPACE program. Payment shall be made under the ConnPACE program for prescription drugs that are not Medicare Part D drugs, as defined in said act.
(3) Payment for a replacement prescription under the program shall be made only
if the eligible person signs a statement, on such form as the commissioner prescribes
and subject to penalty under section 17b-497, that the prescription drug is lost or was
stolen or destroyed and the person has made a good faith effort to recover the prescription
drug, except that payment for a replacement prescription shall not be made on behalf
of a person more than twice in a calendar year.
(c) Any eligible resident who (1) is insured under a policy, including an endorsed
Medicare prescription drug discount card, which provides full or partial coverage for
prescription drugs, and (2) expects to exhaust such coverage, may apply to participate
in the program prior to the exhaustion of such coverage. Such application shall be valid
for the applicable income year. To be included in the program, on or after the date the
applicant exhausts such coverage, the applicant or the applicant's designee shall notify
the department that such coverage is exhausted and, if required by the department, shall
submit evidence of exhaustion of coverage. Not later than ten days after an eligible
resident submits such evidence, such resident shall be included in the program. The
program shall, except for those beneficiaries with an endorsed Medicare prescription
drug discount card, (A) cover prescriptions that are not covered by any other plan of
insurance or assistance available to the eligible resident and that meet the requirements
of this chapter, and (B) retroactively cover such prescriptions filled after or concurrently
with the exhaustion of such coverage. Nothing in this subsection shall be construed to
prevent a resident from applying to participate in the program as otherwise permitted
by this chapter and regulations adopted pursuant to this chapter.
(d) (1) As a condition of eligibility for participation in the ConnPACE program, a
resident with an income at or below one hundred thirty-five per cent of the federal
poverty level, who is Medicare Part A or Part B eligible, shall obtain annually an endorsed Medicare prescription drug discount card designated by the Commissioner of
Social Services for use in conjunction with the ConnPACE program. The commissioner
shall be the authorized representative of such resident for the purpose of enrolling a
resident in the transitional assistance program of Public Law 108-173, the Medicare
Prescription Drug, Improvement, and Modernization Act of 2003. As the authorized
representative for this purpose, the commissioner may sign required forms and enroll
such resident in an endorsed Medicare prescription drug discount card on the resident's
behalf. Such resident shall have the opportunity to select an endorsed Medicare prescription drug discount card designated by the commissioner for use in conjunction with the ConnPACE program, and shall be notified of such opportunity by the commissioner.
In the event that such resident does not select an endorsed Medicare prescription drug
discount card designated by the commissioner for use in conjunction with the
ConnPACE program within a reasonable period of time, as determined by the
commissioner, the department shall enroll the resident in an endorsed Medicare
prescription drug discount card designated by the commissioner. The provisions of this
subdivision shall remain in effect until the effective date of the Medicare Part D program
pursuant to Public Law 108-173, the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003.
(2) The commissioner may require, as a condition of eligibility for participation in
the ConnPACE program, that a resident with an income above one hundred thirty-five
per cent of the federal poverty level, who is Medicare Part A or Part B eligible, obtain
an endorsed Medicare prescription drug discount card designated by the commissioner
for use in conjunction with the ConnPACE program if obtaining such discount card is
determined by the commissioner to be cost-effective to the state. In such an event, the
commissioner may provide payment for any Medicare prescription drug discount card
enrollment fees. The provisions of this subdivision shall remain in effect until the effective date of the Medicare Part D program pursuant to Public Law 108-173, the Medicare
Prescription Drug, Improvement, and Modernization Act of 2003.
(e) On and after the effective date of the Medicare Part D program pursuant to Public
Law 108-173, the Medicare Prescription Drug, Improvement, and Modernization Act
of 2003, enrollment in the Medicare Part D program, for individuals eligible for such
program in accordance with said act, shall be a condition of eligibility for the ConnPACE
program. The ConnPACE program shall cover the financial costs of Medicare Part D
participation for ConnPACE recipients enrolled in Medicare Part D in accordance with
subsection (b) of this section. Effective July 1, 2005, a ConnPACE recipient shall, as a
condition of eligibility, provide information regarding the recipient's assets and income,
as defined by said act, and that of the recipient's spouse, provided said spouse resides
in the same household, as required by the Department of Social Services in order to
determine the extent of benefits for which the recipient is eligible under Medicare Part D.
(f) The Commissioner of Social Services may be the authorized representative of
a ConnPACE applicant or recipient for purposes of enrolling in a Medicare Part D plan
or submitting an application to the Social Security Administration to obtain the low
income subsidy benefit provided under Public Law 108-173, the Medicare Prescription
Drug, Improvement, and Modernization Act of 2003. The applicant or recipient shall
have the opportunity to select a Medicare Part D plan and shall be notified of such
opportunity by the commissioner. The applicant or recipient, prior to selecting a Medicare Part D plan, shall have the opportunity to consult with the commissioner, or the
commissioner's designated agent, concerning the selection of a Medicare Part D plan
that best meets the prescription drug needs of such applicant or recipient. In the event
that such applicant or recipient does not select a Medicare Part D plan within a reasonable
period of time, as determined by the commissioner, the commissioner shall enroll the
applicant or recipient in a Medicare Part D plan designated by the commissioner in
accordance with said act. The applicant or recipient shall appoint the commissioner as
such applicant's or recipient's representative for the purpose of appealing any denial of
Medicare Part D benefits and for any other purpose allowed under said act and deemed
necessary by the commissioner.
(g) The Commissioner of Social Services may adopt regulations, in accordance
with the provisions of chapter 54, to implement the provisions of subsection (c) of
this section. Such regulations may provide for the electronic transmission of relevant
coverage information between a pharmacist and the department or between an insurer
and the department in order to expedite applications and notice. The commissioner may
implement the policies and procedures necessary to carry out the provisions of this
section while in the process of adopting such policies and procedures in regulation form,
provided notice of intent to adopt the regulations is published not later than twenty days
after the date of implementation. Such policies and procedures shall be valid until the
time the final regulations are adopted.
(P.A. 85-573, S. 7, 18; P.A. 87-3, S. 4, 9; June Sp. Sess. P.A. 91-8, S. 47, 63; P.A. 92-196, S. 3, 4; P.A. 93-262, S. 1,
87; P.A. 95-160, S. 1, 69; P.A. 96-139, S. 12, 13; June 18 Sp. Sess. P.A. 97-2, S. 128, 165; P.A. 98-194, S. 1, 2; June Sp.
Sess. P.A. 01-2, S. 22, 69; June Sp. Sess. P.A. 01-9, S. 129, 131; May 9 Sp. Sess. P.A. 02-7, S. 16; P.A. 03-2, S. 15; June
30 Sp. Sess. P.A. 03-3, S. 58; P.A. 04-6, S. 1; 04-101, S. 2; 04-104, S. 2; 04-258, S. 12; P.A. 05-280, S. 22; Nov. 2 Sp.
Sess. P.A. 05-2, S. 3, 4; Nov. 2 Sp. Sess. P.A. 05-3, S. 2.)
History: P.A. 87-3 restated eligibility to include the disabled, changed the income limits to thirteen thousand three
hundred dollars for unmarried persons and sixteen thousand for married, provided for annual adjustments and restated
Subsec. (b) re ineligibility; Sec. 17-514 transferred to Sec. 17a-343 in 1991; June Sp. Sess. P.A. 91-8 changed the income
limits to thirteen thousand eight hundred dollars for unmarried persons and sixteen thousand six hundred dollars for married
persons and added a fifteen dollar registration fee; P.A. 92-196 amended Subsec. (a) by limiting eligibility to those not
insured under a policy providing full or partial prescription coverage once a deductible is met; P.A. 93-262 authorized
substitution of commissioner and department of social services for commissioner and department on aging, effective July
1, 1993; Sec. 17a-343 transferred to Sec. 17b-492 in 1995; P.A. 95-160 increased the registration fee of fifteen dollars to
an annual fee of twenty-five dollars, effective July 1, 1995; P.A. 96-139 changed effective date of P.A. 95-160 but without
affecting this section; June 18 Sp. Sess. P.A. 97-2 amended Subsec. (a) to require the commissioner to increase the income
limits to reflect any annual inflation adjustment in Social Security income after January 1, 1998, effective July 1, 1997;
P.A. 98-194 added Subsecs. (c) and (d), extending program to eligible residents who exhaust prescription drug insurance
coverage, effective July 1, 1998; June Sp. Sess. P.A. 01-2 amended Subsec. (a) to make a technical change for purposes
of gender neutrality, to change annual income limits applicable after April 1, 2002, or in the case of a federal waiver,
after July 1, 2002, and to require the commissioner, effective January 1, 2002, to commence accepting applications from
individuals who will become eligible to participate in the program as of April 2, 2002, and amended Subsec. (c) to make
technical changes, effective July 1, 2001; June Sp. Sess. P.A. 01-9 revised effective date of June Sp. Sess. P.A. 01-2 but
without affecting this section; May 9 Sp. Sess. P.A. 02-7 amended Subsec. (a) by deleting requirement that commissioner
adopt regulations re increased eligibility income limits, effective September 1, 2002; P.A. 03-2 amended Subsec. (a)(4)
to increase annual registration fee from twenty-five dollars to thirty dollars, effective February 28, 2003; June 30 Sp. Sess.
P.A. 03-3 amended Subsec. (a) by adding new Subdiv. (4) limiting program eligibility to unmarried individuals with
available assets below one hundred thousand dollars and married individuals with assets below one hundred twenty-five
thousand dollars, and providing that asset limit for married individuals be determined by combining value of assets available
to both spouses and that for purposes of section "available assets" are those considered available under the Connecticut
Home Care Program for the Elderly, and by redesignating existing Subdiv. (4) as Subdiv. (5), effective August 20, 2003;
P.A. 04-6 amended Subsec. (a)(2)(A) by deleting Subpara. (A) designator, increasing income eligibility level to twenty
thousand eight hundred dollars for unmarried persons and increasing the combined income level for married persons to
twenty-eight thousand one hundred dollars, deleted Subsec. (a)(2)(B) re income levels in the event of waiver being granted,
amended Subsecs. (a) to (c), inclusive, by adding provisions re use of Medicare prescription drug discount cards by program
beneficiaries, added new Subsec. (d) requiring that persons with income at or below one hundred thirty-five per cent of the
federal poverty level obtain Medicare prescription drug discount card as a condition of program eligibility, and redesignated
existing Subsec. (d) as Subsec. (e) and added provisions authorizing commissioner to implement policies and procedures
relative to section while in process of adopting such policies and procedures as regulation, effective March 30, 2004; P.A.
04-101 amended Subsec. (d) to insert Subdiv. (1) and (2) designators and, in Subdiv. (1), inserted "annually" re requirement
to obtain a discount card, required that the commissioner be the authorized representative of a resident in enrolling the
resident in the transitional assistance program, authorized the commissioner to enroll the resident and allowed the resident
to select an endorsed discount card, effective April 28, 2004; P.A. 04-104 amended Subsec. (b) to designate existing
provisions as Subdiv. (1) and add Subdiv. (2) re payment for replacement prescriptions, effective July 1, 2004; P.A. 04-258 eliminated former Subsec. (a)(4) re asset limits used in making program eligibility determinations and redesignated
existing Subsec. (a)(5) as new Subsec. (a)(4), effective June 1, 2004; P.A. 05-280 amended Subsec. (a) by changing "annual
income" to "current annual income at the time of application or redetermination" in Subdiv. (2), repositioning "once a
deductible is met" and adding reference to coverage under Medicare Part D in Subdiv. (3) and deleting provision re accepting
applications from persons eligible for program, amended Subsec. (b) by adding "or benefits provided under Medicare Part
D" in Subdiv. (1), adding new Subdiv. (2) re Medicare Part D, redesignating existing Subdiv. (2) as Subdiv. (3) and
amending same by deleting provision re no copayment required for replacement prescription, amended Subsec. (d) by
making technical changes and adding language re provisions of Subdivs. (1) and (2) to remain in effect until effective date
of the Medicare Part D program, added new Subsecs. (e) and (f) re Medicare Part D and redesignated existing Subsec. (e)
as Subsec. (g), effective July 1, 2005; Nov. 2 Sp. Sess. P.A. 05-2 amended Subsec. (b)(2) by deleting former Subpara. (A)
re department's authority to pay for a prescription drug at the lowest price established by the Medicare Part D plan for a
preferred drug in the same therapeutic class and category, with the client responsible for any cost differential, and by
redesignating existing Subparas. (B) and (C) as Subparas. (A) and (B), and amended Subsec. (f) by providing that applicant
or recipient, prior to selecting a Medicare Part D plan, shall have the opportunity to consult with commissioner or commissioner's designated agent concerning selection of a plan that best meets the prescription drug needs of such applicant or
recipient, effective December 1, 2005; Nov. 2 Sp. Sess. P.A. 05-3 amended Subsec. (f) by changing "shall" to "may" re
commissioner's acting as authorized representative of a ConnPACE applicant or recipient, adding provision clarifying
commissioner's authority to enroll such applicant or recipient in a Medicare Part D plan, and deleting provision re commissioner's authority to sign required forms on behalf of such applicant or recipient, effective December 1, 2005.
Sec. 17b-492b. Authority of Commissioner of Mental Retardation with respect to the Medicare Part D program. The Commissioner of Mental Retardation, or
the commissioner's designee, may be the authorized representative of an applicant or
recipient of services provided by the Department of Mental Retardation for the purpose
of submitting an application to the Social Security Administration to obtain the low
income subsidy benefit provided under Public Law 108-173, the Medicare Prescription
Drug, Improvement, and Modernization Act of 2003. As the authorized representative
for this purpose, the commissioner, or the commissioner's designee, may also sign required forms and enroll the applicant or recipient in a Medicare Part D plan on the
applicant's or recipient's behalf. The applicant or recipient shall have the opportunity
to select a Medicare Part D plan and shall be notified of such opportunity by the commissioner. In the event that such applicant or recipient does not select a Medicare Part D
plan within a reasonable period of time, as determined by the commissioner, the department shall enroll the applicant or recipient in a Medicare Part D plan designated by the
commissioner in accordance with said act. The applicant or recipient shall appoint the
commissioner, or the commissioner's designee, as such applicant's or recipient's authorized representative for the purpose of appealing any denial of Medicare Part D benefits
and for any other purpose allowed under said act and deemed necessary by the commissioner.
(P.A. 05-280, S. 28.)
History: P.A. 05-280 effective July 1, 2005.
Sec. 17b-492c. Authority of Commissioner of Mental Health and Addiction
Services with respect to the Medicare Part D program. The Commissioner of Mental
Heath and Addiction Services, or the commissioner's designee, may be the authorized
representative of an applicant or recipient of services provided by the Department of
Mental Health and Addiction Services for the purpose of submitting an application to
the Social Security Administration to obtain the low income subsidy benefit provided
under Public Law 108-173, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. As the authorized representative for this purpose, the commissioner,
or the commissioner's designee, may also sign required forms and enroll the applicant
or recipient in a Medicare Part D plan on the applicant's or recipient's behalf. The
applicant or recipient shall have the opportunity to select a Medicare Part D plan and shall
be notified of such opportunity by the commissioner. In the event that such applicant or
recipient does not select a Medicare Part D plan within a reasonable period of time, as
determined by the commissioner, the department shall enroll the applicant or recipient
in a Medicare Part D plan designated by the commissioner in accordance with said
act. The applicant or recipient shall appoint the commissioner, or the commissioner's
designee, as such applicant's or recipient's authorized representative for the purpose of
appealing any denial of Medicare Part D benefits and for any other purpose allowed
under said act and deemed necessary by the commissioner.
(P.A. 05-280, S. 29.)
History: P.A. 05-280 effective July 1, 2005.
Sec. 17b-499. Pharmacy outreach program: Definitions. As used in this section
and section 17b-499a:
(1) "Eligible person" means any person who is a resident of Connecticut at the
time such person files an application for prescription medications or nonprescription
medications with a participating manufacturer;
(2) "Department" means the Department of Social Services;
(3) "Participating manufacturer" means a pharmaceutical manufacturer that offers
prescription medications or nonprescription medications at a reduced cost or at no cost
to persons pursuant to a voluntary drug assistance program established by such manufacturer;
(4) "Prescription medications" means prescription drugs that have been approved
as safe and effective by the federal Food and Drug Administration or that are otherwise
legally marketed and manufactured in the United States and manufactured and offered
by pharmaceutical companies.
(P.A. 05-269, S. 1.)
History: P.A. 05-269 effective July 13, 2005.
Sec. 17b-499a. Pharmacy outreach program. Established. Purpose. Duties.
Report by Department of Social Services. (a) There is established a pharmacy outreach
program, administered by participating manufacturers through a toll-free telephone
number, for the purpose of assisting residents of this state in obtaining reduced cost
or no cost prescription medications or nonprescription medications from participating
manufacturers and educating such residents about all available programs in Connecticut
relating to such medications. The department, within available appropriations, shall
oversee such program.
(b) The pharmacy outreach program shall assist eligible persons in procuring free
or low cost prescription medications or nonprescription medications by: (1) Evaluating
the likelihood that such eligible person will qualify to receive reduced cost or no cost
prescription medications or nonprescription medications from a participating manufacturer based upon such participating manufacturer's eligibility requirements for participation in such manufacturer's voluntary drug assistance program; (2) aiding eligible
persons who qualify to receive such reduced cost or no cost prescription medications
or nonprescription medications in receiving such medications from such participating
manufacturers; and (3) assisting any physician licensed in this state with communications to any such participating manufacturer that concern the application of any such
eligible person for participation in such participating manufacturer's voluntary drug
assistance program.
(c) The pharmacy outreach program shall: (1) Create and maintain a state-wide toll-free telephone number staffed by individuals who are qualified to advise eligible persons
on questions such persons may have about access to reduced cost or no cost prescription
drugs or nonprescription drugs; (2) sponsor and organize materials and information, in
conjunction with other organizations, concerning issues relating to access to affordable
prescription medications; and (3) offer and provide information on prescription medications and nonprescription medications, including, but not limited to, information on
drug interactions and drug abuse.
(d) Not later than January 15, 2006, and annually thereafter, upon the request of
the joint standing committees of the General Assembly having cognizance of matters
relating to human services and general law, the Department of Social Services shall
report, in accordance with section 11-4a, on the number of telephone calls received
by the pharmacy outreach program, the number of prescriptions requested and issued
through the program and any other information relating to the program that the department deems relevant.
(P.A. 05-269, S. 2.)
History: P.A. 05-269 effective July 13, 2005.